This Mentored Patient-Oriented Research Career Development Award (K23) will prepare the candidate to conduct and advance clinical research focusing on the effectiveness and mechanisms of mind-body practices for patients with chronic disease. Utilizing patients with end-stage renal disease (ESRD) on maintenance hemodialysis (MHD) as a model of chronic disease, the candidate will develop clinical research skills through advanced training and mentorship to conduct clinical research of the therapeutic application of yoga practice during MHD. MHD is a life-sustaining treatment for many patients with ESRD. Despite treatment, patients receiving MHD have significantly decreased quality of life, poor physical function and mood disorders. The ESRD population has a high mortality due to cardiovascular risk factors including hypertension, diabetes, sedentary behavior, autonomic dysfunction, endothelial dysfunction and arterial stiffness. Mind-body practices, such as yoga, may provide a novel therapeutic intervention for patients with ESRD to improve quality of life, symptoms associated with disease, and reduce cardiovascular risk factors. The candidate's short term goals are to gain: 1) methodological skills and experience in clinical research; 2) knowledge to measure and interpret cardiovascular and autonomic physiology and behavioral outcomes in clinical studies to characterized mind-body practices and elucidate potential mechanisms of action; 3) experience in the implementation of mind-body practices in a chronic disease population i.e. adaptation of yoga therapeutically for patients with ESRD. The candidate has proposed a career development plan which will be guided by mentors and collaborators with expertise in clinical trials, chronic disease, health behavior, physiology, and mind-body practices. Through focused didactics in clinical research methodology and laboratory training to measure relevant cardiovascular physiology, the candidate will acquire the necessary skills to conduct proposed and future research. The proposed research will implement an intra-dialysis yoga protocol and determine feasibility by measuring adherence to practice and fidelity of the intervention in a pilot study (n=12) of yoga among patients on MHD (Specific Aim 1). The candidate will then design and conduct a clinical trial (n=60) of intra-dialysis yoga (IDY) to measure the effect of the practice on health related outcomes including quality of life, physical function, self-efficacy, blood pressure, and mood (Specific Aim 2a). As a sub- study to the clinical trial (n=20), the candidate will investigate potential cardiovascular mechanisms of yoga practice through measurement of endothelial function, arterial stiffness, and autonomic tone among patients on MHD (Specific Aim 2b). MHD provides an innovative setting to apply the mind-body practices, by facilitating access to this chronic disease population, quantification of yoga dose, and collection of outcome variables. These projects will inform and advance implementation of MBP for patients with chronic disease. Importantly, the proposed research will provide the candidate with hands-on clinical research experience to develop into a successful independent investigator trained to implement and evaluate mind-body practices for patients with chronic disease.